To the Editor.—In the article by Dr Sisk and colleagues,1 the authors draw the conclusion that patients have improved access to care and higher levels of satisfaction when compared with conventional Medicaid (non—managed care) beneficiaries. However, the sampling methods may not be valid because patients who are enrolled in the program may not have sought care from an emergency department or hospital if they were healthy. If patients do not have contact with the representatives of the managed care organization that provides their health care, how can they possibly rate how satisfied they are with the program?One clear improvement in some of the managed care Medicaid programs is that they do designate a physician and hospital for the patients to have access to care. This is a clear departure from Medicaid non—managed care programs where patients are left to "shop" for a physician who will take Medicaid.